I don't have any personal experience with teenagers who have bipolar disorder but felt it was a worthwhile topic. When children or young teenagers develop bipolar it is referred to as Early Onset Bipolar Disorder. A woman I know (I'll call her Cathy) struggles daily, sometimes hourly with her young daughter. Her daughter is now 16 and has been ill for almost four years. She has been diagnosed with Bipolar Disorder II and presents mostly with depression. From most of my reading, Early Onset Bipolar is more severe than adult bipolar. Mood changes are more frequent and symptoms are greater. The mania (or hypomania) generally presents with irritability and aggression, rather than euphoria. Imagine the challenges of puberty and teenage life, and then add bipolar disorder. It is a demanding existence. School is a huge stressor for Cathy's daughter. She has yet to write an exam or finish a whole semester in a regular classroom. Our local hospital has a mental health classroom for teens. Cathy has also utilized tutors that come to their home. When her daughter is well, she is an A student, but large assignments send her into depression. As with adults, she suffers from weight gain. Cathy explains how that is horrible for a young teen and wreaks havoc on her self-esteem. She has been told that regular exercise will help but as anyone fighting depression knows, finding the energy for that is almost impossible. One of Cathy's worst fears is her daughter's suicidal thoughts – there are many and some were quite serious. Cathy has even had to leave work in the middle of the day to check on her daughter out of worry. Cathy talks about how her daughter has lost almost every friend she's ever had. Losing friends is also common among adult patients but friendships are so important to teenagers and their lifestyle. Her sleep is disrupted and she spends many days just laying in bed. Medication has been hit and miss but does seem to help a bit. Cathy is fortunate that she has a very close relationship with her daughter. She describes herself as being her anchor in the storm. She relies heavily on her for everything. Cathy has done something very smart – she has started psychotherapy herself. She describes it as being very emotional but knows to be able to help her daughter she needs to stay mentally healthy herself.